Transversus Abdominis Plane Block: An Updated Review of Anatomy and Techniques

Abstract

Purpose of Review Transversus abdominis plane (TAP) block is a regional technique for analgesia of the anterolateral abdominal wall. This review highlights the nomenclature system and recent advances in TAP block techniques and proposes directions for future research. Recent Findings Ultrasound guidance is now considered the gold standard in TAP blocks. It is easy to acquire ultrasound images; it can be used in many surgeries involving the anterolateral abdominal wall. However, the efficacy of ultrasound-guided TAP blocks is not consistent, which might be due to the use of different approaches. The choice of technique influences the involved area and block duration. To investigate the actual analgesic effects of TAP blocks, we unified the nomenclature system and clarified the definition of each technique. Although a single-shot TAP block is limited in duration, it is still the candidate of the analgesic standard for abdominal wall surgery because the use of the catheter technique and liposomal bupivacaine may overcome this limitation. Summary Ultrasound-guided TAP blocks are commonly used. With the unified nomenclature and the development of catheter technique and/or liposomal local anesthetics, TAP blocks can be applied more appropriately to achieve better pain control.

The TAP block in obese patients: pros and cons

“…Subcostal or dual (subcostal + lateral/ posterior) blocks are required for analgesia of the supraumbilical wall. 2 Ultrasound guidance is the gold standard for identifying the taP during the block, because, when compared with landmarkbased techniques, it increased the success rate and the safety of this procedure. 3 the taP block is technically simple in expert hands, provides excellent analgesia for a variety of abdominal procedures, reduces postoperative opioid consumption, and has a relatively long duration of action.…”

Pain Control after Laparoscopic Radical Prostatectomy: Comparison between Unilateral Transversus Abdominis Plane Block and Wound Infiltration

“…In the past decade, there has been growing evidence supporting the effectiveness of the TAP block for a variety of abdominal surgeries. With the advancement of ultrasound technology, TAP block becomes technically more accessible and safer to perform [11]. The analgesic effect of TAP block could last several hours (0-12 h) and could also be extend- ed by the addition of dexamethasone to bupivacaine [13,14].…”

“…After aspiration, we injected 1 mL of study solution. Only when the satisfactory needle placement was identified, as visualized by the operator as a hypoechoic lens-shaped space between IO and TA, the total of 20 mL of the anesthetic is injected [11] (Fig. 2b).…”

“Minimally invasive” regional anesthesia and the expanding use of interfascial plane blocks: the need for more systematic evaluation

“…L'obtention de données probantes concernant l'utilité d'un bloc est toutefois une tâche ardue, et il peut se passer un certain temps avant qu'une recommandation concluante ne puisse être émise. Par exemple, la première description d'un bloc du plan du muscle transverse de l'abdomen (TAP) remonte à 2001, 12 par la suite, diverses approches ont été décrites, 13 accompagnées de données probantes soutenant 14 ou réfutant 15 son efficacité analgésique. Cette technique n'a toujours pas été évaluée par une étude clinique randomisée multicentrique d'envergure.…”

“…Nevertheless, obtaining evidence of any block's utility is an arduous task and it may take a long time before conclusive recommendations can be made. For example, the initial description of the transversus abdominis plane (TAP) block dates back to 2001, 12 and subsequently, a variety of approaches have been described 13 with evidence both for 14 and against 15 its analgesic efficacy. There is still a need for large-scale multicentre randomized clinical trial to evaluate this technique.…”